Legislation, policies and organization of community based Centers for HIV diagnosis and prevention in Piedmont Region.

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Legislation, policies and organization of community based Centers for HIV diagnosis

and prevention in Piedmont Region.

Author’s Details:

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Tradori Vania (2)Biancone Paolo Pietro (3)Silvana Secinaro (4)Brescia Valerio

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Tradori V., University Researcher at the Department of Management, University of Turin (2)Biancone P.P., Full Professor at the Department of Management, University of Turin (3)Secinaro S., University Researcher at the Department of Management, University of Turin (4)Brescia V., PhD candidate at the Department of Management,

University of Turin

Corresponding Author: Brescia V., Department of Management, University of Turin Corso Unione Sovietica 218

Bis, I – 10134 Turin Abstract:

The article describes how the fight against AIDS is tackled, from an organizational and legislative point of view, especially with regard to HIV test offer to as many people as possible, with a focus on people with higher at-risk behaviors, in order to reduce the cases of immunodeficiency and unawareness of the serological state. The community-based services and the implementing policies of Piedmont Region answer to the need for integration already offered by the Regional Health Service. The features and results confirmed by a pilot project can be a useful reference for the activation of integrated services on the territory.

Key Words: HIV, community-based, legislation, and organization of diagnosis centers. Introduction

Epidemiological situation

At the end of 2010, UNAIDS (Joint United Nations Programme on HIV/AIDS) estimated 33 million people living with HIV/AIDS worldwide. In 2009, 2.6 million new infections and 1.8 million deaths due to AIDS were reported. Sub-Saharan Africa is the most affected region, with 1.8 new cases per million inhabitants in 2009, followed by South-East Asia and Eastern Europe. The spread of the acquired immune deficiency virus in the European area has a strong geographical variability, mainly linked to economic and social differences. The number of AIDS and HIV notifications is high in Western Europe, but the trend is descending as a result of extensive access to antiretroviral therapy (effective in preventing clinical progression of infection) and of the successful outcome of prevention and information programmes. In Eastern Europe, there is a continuous increase in AIDS and HIV notifications due to the limits of the answer of health systems to HIV epidemic and to the reduced access to HAART. Central Europe countries, on the other hand, are less concerned about this epidemic. In Italy, data collection on AIDS cases started in 1982, and in June 1984 it was formalized in a National Surveillance System, according to which, in 2010, 4.0 new cases of HIV positivity were diagnosed every 100,000 Italian residents and 20.0 new cases of HIV positivity every 100,000 foreign residents. In 2010, almost one person out of three diagnosed as HIV positive had a foreign nationality. The incidence is higher in Center-North than in the South-islands. Over the past 10 years, there is a stabilization of the reports in the areas where the datum is available. People who discovered to be HIV positive in 2010 have a median age of 39 years old for males and 35 for females. The proportion of women has risen until the mid-1990s, and since 2003 it has been declining: the male/female ratio, which was 2.3 in 2003, became 3.2 in 2010.

Cases ascribable to heterosexual and homosexual contacts are increasing: in 2010 they accounted together for 80.7% of all reports. One-third of people with a new diagnosis of HIV is diagnosed at an advanced stage of illness, with a significant impairment of the immune system (number of CD4 lymphocytes less than 200 cells / mm3).

New AIDS cases per year continue to decrease mainly because of combined antiretroviral therapies (introduced in our country in 1996). Such therapies prolong survival and reduce the mortality of HIV-positive people, leading to a progressive increase in the number of people living with AIDS. The characteristics of people with AIDS have changed over the past 10 years: cases involving injective drug use decreased, the median age of people with AIDS increased, and cases of sexual contact increased (both

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heterosexual and homosexual, with the first ones being on the rise). An increasing proportion of people find themselves to be HIV positive very late, concurrently with the diagnosis of AIDS. As a result of these late diagnoses, two-thirds of people diagnosed with AIDS from 1996 to 2010 did not benefit from antiretroviral therapies before such diagnosis.

Piedmont Region Prevention Plan 2014 – 2018

The Regional Prevention Plan 2014-2018 (RPP) is designed to continue to respect the vision already enunciated in the National Plan for Prevention (NPP) and the principles that must be applied to public health: - the centrality of health understood as a universal common good and therefore also as an inalienable right of every individual and interest of the community;

- social equity and equal health opportunities for everyone;

- the involvement of local authorities to make the best use of the health potential in all policies, even non-health ones;

- communication and listening;

- the integration of all the services of the socio-sanitary system and the collaboration with all the institutional components of the social fabric and volunteering;

- effectiveness and appropriateness, with rigorous application of the principles of scientific evidence, of action for health priority and transparency of choices;

- the sobriety and sustainability of interventions; - the empowerment and participation of all operators.

The Plan sets common priority objectives in the NPP path, which answer to considerable health needs, identified at national and regional level.

These priority objectives are defined and explained through context analysis and identification of determinants / risk factors to:

- reduce the burden of disease by strengthening the health service's contribution to the welfare system. This is particularly true of the objectives connected to the reduction of premature mortality from non-transmissible chronic diseases, with the reduction of accidents and occupational diseases as well as with the promotion of active ageing;

- invest in the well-being of children and young people. It is a choice of strong formative and empowerment content that aims to promote, in a "life course" approach which favours early interventions, contexts favourable to the development of responsibility and personal skills that concern the proposal of healthy lifestyles, the pursuit of mental wellbeing, the adoption of behavioural rejection of dependencies and risk behaviours;

- strengthen and confirm the common heritage of effective preventive practices that have been consolidated over the years, even in relation to national planning acts (preventive interventions in life and workplaces, infectious disease prevention, vaccinations, food safety, etc.);

- strengthen and put at the system the focus on fragile groups;

- consider the individual and the populations in relation to their environment by promoting a healthy relationship between health and the environment and by developing the potential for the inter-institutional approach of health service;

- consider the interaction between socioeconomic and cultural conditions and personal lifestyle in a setting approach aimed at long-term organizational, cultural and health changes, with particular attention to the European strategies outlined in the WHO-Europe Action Plan NCD 2016/2020 regarding school environment (Network Schools for Health in Europe, SHE) and work environment (Network Workplace Health Promotion, WHP).

A key role in achieving these goals is played by awareness campaigns, which are applied in different contexts, such as in schools and communities. As far as resources are concerned, prevention activities are part of the healthcare services funded by the Health Fund and, as such, they must be included in the company's organization and in the action programmes of Prevention Department’s Services and of Business Structures involved in the Local Preventive Plans. This means that the resources allocated for prevention (5% of NHF-National Healthcare Fund-+ Structured Funds) are actually used for preventive interventions which

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burden on the functioning of weakened structures affected by the measures to reduce public spending and by the constraints imposed by the Plan of return.

Among the various programmes that are expected in order to reach the above goals, there is the one to reduce the frequency of infections / priority infectious diseases, including sexually transmitted infections and HIV, of which the Plan states: "In Piedmont, the total burden of sexually transmitted infections, including HIV infection, is such as to fully address their prevention and control among public health problems on which it is essential to intervene. "

In Piedmont, more than 3,000 people per year receive a diagnosis of sexually transmitted infection and about 300 Piedmontese find out that they contracted HIV infection (among them there is still a very high number of people arriving late to diagnosis when the immune system is already compromised or even when AIDS has already been developing).

Since the early 2000s, a network of 9 Centers has been active in Piedmont. It provides effective action to fight the spread of sexually transmitted infections by carrying out activities of surveillance, prevention, diagnosis and treatment of STIs in a homogeneous way and by adopting internationally recommended diagnosis and treatment protocols.

The Regional Prevention Plan 2014-2018 (RPP) is designed to continue to respect the vision already set out in the National Plan for Prevention (NPP) and the principles that must be applied to public health:

- the centrality of health understood as a universal common good and therefore also as an inalienable right of every individual and interest of the community;